骨科英文书籍精读（50）｜骨折晚期并发症之病理骨折（2）
X-ray
Understandably, the fracture itself attracts most attention but the surrounding bone must also be examined, and features such as cyst formation, cortical erosion, abnormal trabeculation and periosteal thickening should be sought. The type of fracture, too, is important: vertebral compression fractures may be due to severe osteoporosis or osteomalacia, but they can also be caused by skeletal metastases or myeloma.
Middle-aged men, unlike women, do not normally become osteoporotic: x-ray signs of bone loss and vertebral compression in a male younger than 75 years should be regarded as ‘pathological’ until proven otherwise.
Additional investigations
Local radionuclide imaging may help elucidate the diagnosis, and whole-body scanning is important in revealing or excluding other deposits.
X-ray of other bones, the lungs and the urogenital tract may be necessary to exclude malignant disease.
Investigations should always include a full blood count, ESR, protein electrophoresis, and tests for syphilis and metabolic bone disorders.
Urine examination may reveal blood from a tumour, or Bence–Jones protein in myelomatosis.
Biopsy
Some lesions are so typical that a biopsy is unnecessary (solitary cyst, fibrous cortical defect, Paget’s disease). Others are more obscure and a biopsy is essential for diagnosis. If open reduction of the fracture is indicated,the biopsy can be carried out at the same time; otherwise a definitive procedure should be arranged.
---from 《Apley’s System of Orthopaedics and Fractures》P687-688
重点词汇整理：
cortical erosion皮质侵蚀/ɪˈroʊʒn/n. 侵蚀，腐蚀
trabeculation小梁形成
periosteal thickening骨膜增厚
osteomalacia /,ɑstɪomə'leʃə/n. [外科] 骨软化；[内科] 软骨病
malacia /mə'leisiə/n. 软化
myeloma./ˌmaɪəˈloʊmə/n. [肿瘤] 骨髓瘤
radionuclide imaging放射性核素显像
/'redɪo'njʊ,klaɪd/n. [核] 放射性核素
elucidate /ɪˈluːsɪdeɪt/vt. 阐明；说明
urogenital tract 泌尿生殖道 /,jʊro'dʒɛnətl/adj. [解剖] 泌尿生殖器的
malignant /məˈlɪɡnənt/adj. [医] 恶性的；有害的；有恶意的
full blood count全血计数
protein electrophoresis蛋白电泳
phoresis /fəu'ri:sis/n. 电泳现象（等于cataphoresis）；携运
syphilis /ˈsɪfɪlɪs/n. [性病] 梅毒
metabolic bone disorders.代谢性骨病
Bence–Jones protein本-周蛋白
myelomatosis骨髓瘤；骨髓性白血病
Biopsy /ˈbaɪɑːpsi/n. 活组织检查；活组织切片检查；切片检查法
obscure /əbˈskjʊr/adj. 昏暗的，朦胧的；晦涩的，不清楚的；隐蔽的；不著名的，无名的vt. 使…模糊不清，掩盖；隐藏；使难理解n. 某种模糊的或不清楚的东西
百度翻译：
X射线
可以理解的是，骨折本身最受关注，但也必须检查周围的骨骼，并寻找囊肿形成、皮质侵蚀、小梁异常和骨膜增厚等特征。骨折的类型也很重要：椎体压缩性骨折可能是由于严重的骨质疏松或骨软化所致，但也可能是由骨转移或骨髓瘤引起的。
与女性不同的是，中年男性通常不会变成骨质疏松症：75岁以下男性骨质丢失和椎体压缩的x光征象应被视为“病理性”，除非另有证明。
附加检查
局部放射性核素显像有助于明确诊断，全身扫描对揭示或排除其他沉积物具有重要意义。
其他骨骼、肺部和泌尿生殖道的X线检查可能是排除恶性疾病的必要手段。
调查应始终包括全血细胞计数、血沉、蛋白质电泳、梅毒和代谢性骨疾病测试。
尿检可显示肿瘤的血液，或骨髓瘤病中的Bence-Jones蛋白。
活检
有些病变非常典型，不需要活检（孤立性囊肿、纤维皮质缺损、Paget病）。其他的则比较模糊，活检是诊断的关键。如果显示骨折切开复位，可同时进行活检；否则应安排明确的手术。